Cardiac Rehabilitation Baseline Review and Strategy development. Rose Batten Nurse Clinical Lead Sue Wilshere Network Manager SEWCN

Transcription

1 Cardiac Rehabilitation Baseline Review and Strategy development Rose Batten Nurse Clinical Lead Sue Wilshere Network Manager SEWCN 1

2 Cardiac Disease NSF Std 6 Everyone with established coronary heart disease is offered an appropriate evidence-based cardiac rehabilitation plan and has the high quality, multi-disciplinary cardiac rehabilitation support they need to achieve this plan.

3 Assembly Directives Develop and implement a strategy (by Dec 2008) for the systematic referral of all clinically appropriate patients to Cardiac Rehabilitation Teams staffed and providing services in accordance with agreed guidelines as set out in the Quality Requirements. Guidelines should be based on Cardiac Network-agreed guidance. Strategic Framework Each LHB, working together through the Cardiac Network, must assess current cardiac rehabilitation provision against the requirements of the NSF Standards and submit a Network level action plan for the delivery of the NSF Standards to the relevant Regional Office by 31 December Peter Lawlor letter 27/02/08

4 Drivers for developing Network strategy Cardiac Disease NSF, Std 6 Developing CR Services in Wales Peter Lawlor letter 2/08 Key Action 29 in Cardiac Disease Strategic Framework NICE Guidelines BACR BHF Co-ordinated ordinated Campaign, political awareness raising by patients 4

5 Cardiac Rehabilitation Phases Phase 1 In hospital.. Patients are seen by a cardiac rehab nurse for safe discharge and early recovery information Phase 2 Post discharge. home. visit or telephone call within timescale standards of (BACR) Phase 3 Structured programme of education and exercise commencing within recommended timescales (BACR) Phase 4 community exercise, support 5

6 Baseline Review data 06/07 Questionnaire developed by Mid & West Network Based on Quality Requirements (QRs) + additional data Circulated to all Cardiac Rehabilitation centres in Wales Completed by all 8 centres in SE Wales Data from all questionnaires collated by Mark Bowers (RGH) Draft Baseline Review report being finalised Full picture of compliance with QRs across region 6

7 Limitations of Baseline and NACR Data Rigorous data collection new to CR Inconsistencies in data collection Interpretation/misinterpretation of questionnaire Difficulties in accessing data QRs broad NACR data completion variable 7

8 Initial Key Findings (SE Wales) CR services are inequitable Benchmarking identifies inequities and variations in: Patient Groups offered CR Referral pathways Staffing Levels and skill mix Funding for CR Models of service 8

9 Patient groups Phase 1 in hospital N/A DGH Procedures Carried out in in tertiary Centres only Some patients repatriated to Nhall for phase 1 9

10 Patient Groups phase 2 immediate post discharge home visit or phone MI Angina Post PCI CABG Heart Failure Pace maker ICD Valve Surgery Prince Charles Charles a a a a a a a a Royal Glamorgan Glamorgan a a a a X r r a Cardiff & Vale Vale a r r a X r r a Neville Hall Torfaen St Woolos Caerphilly Pontypool a a a a a r a a Trust a a a X a r a a a a a X r a a a r a a X r a a a r a a a r a a 10

11 Patient Groups phase 3 3 Core structured programme MI Angina Post PCI CABG Heart Failure Pace maker ICD Valve Surgery Prince Charles Charles a a a a a a a a Royal Glam Cardiff & Vale a a a a r r r Ex only Vale a r r a r r r a Neville Hall Hall a a a a a r a a Torfaen St Wools Caerphilly Pontypool a a a a r a r a a a a a r a a a a r a a r r a a a r a a a r a a r 11

12 Staffing - recommended levels per 500 patients (SIGN) 2007 Specialist Nurse Specialist Physiotherapist Dietitian Pharmacist Clinical Psychologist Audit and Clerical 3.0 WTE 2.0 WTE 0.3 WTE 0.2 WTE 0.2 WTE 0.5 WTE 12

13 Actual Staffing Levels measured against Recommended Staffing Levels and applied to current referral Numbers Referral nos Cardiac Nursing Physiotherapy Dietitian Pharmacist Psychological support PCH RGH C&V NH Torfaen St Woolos CDMH Pontypool Admin

14 Total Budget Annual Treatment Cost per Patient Number of Referrals Treatment Cost Per Patient North Cwm Taf 114, South Cwm Taf 410, Cardiff and Vale 257, Neville Hall 346, Torfaen 75, St Woolos 150, Caerphilly 114, Pontypool 51, Expenditure per patient varies enormously within SE Wales, as services vary considerably. Cardiac rehab is considered as being highly cost effective at approximately 550 per patient (NICE 2008). 14

15 Funding Sources Core Funding Short term IIHF - ceased Short term Big Lottery - ceased Charity Voluntary Input Funding can be different for different Patient Groups in same hospital - inequities 15

16 All Wales CR Group recommnedations That health communities follow the recommendations of the All Wales CR Group in initially offering cardiac rehabilitation to post MI, post surgery and post PCI patients (to be confirmed ) That any additional funding for CR should be targeted first at those areas with lowest CR provision in order to work towards equity across SE Wales That documented guidelines and referral criteria that are consistent with network-agreed guidance are developed. Consensus guidelines on the optimal model for Cardiac Rehabilitation available shortly from the All Wales Cardiac Rehabilitation Working Group,, will help guide local service redesign where this is considered necessary

17 Conclusions Widely varying provision across SE Wales Funding, staffing levels and mix, referral pathways and models of service all variable Cardiac Rehab not offered to all patients or even priority patient groups Demand is managed by rationing access With aging population demand for CR will increase Available data not yet sufficiently reliable 17

18 Network Recommendations That the new LHBs aim to offer the same, equitable high quality provision of cardiac rehabilitation to all patients in SE Wales That the new LHBs work towards meeting the NSF and QRs and SF in a phased manner, moving from existing service provision towards achieving the standards in the NSF by 2015 That health communities follow the recommendations of the All Wales CR Group in initially offering cardiac rehabilitation to post MI, post surgery and post PCI patients (to be confirmed ) 18

19 Recommendations Cont d That the new LHBs prioritise the same level of CR to all priority patient groups in their area, before developing further services. To WAG - that any new funding for CR should be targeted first at those areas with lowest CR provision in order to work towards equity across SE Wales CR should be included as part of the patients integral treatment in any treatment targets That all services undertake a modernisation review to ensure maximum efficiency 19

20 Next steps Further analyse data and finalise baseline review Use NPHS demand/capacity tool to quantify resources needed Add feedback from BHF patient focus groups Add NACR Annual Statistical Report 2008 regional data (if sufficiently reliable) Add all Wales CR Working Group consensus on priority patient groups and minimum programme Network level Action Plan progress report to Regional Office by 31 Dec 2008 Health Communities produce final local action plans for service development by Feb 2009 Final Network level Action Plan to RO by end March